Chiropractic treatment to optimize muscle-skeletal motion, re-establish proper nerve flow, and improve posture will help eliminate the acquired sources of TOS and manage the symptoms of structural TOS. Chiropractic care for thoracic outlet syndrome will be performed on the cervical spine, thoracic spine, ribs, shoulders, and upper extremities. Massage and stretching of the tight muscles may lessen the nerve impingement by reducing muscle tension and re-educating the muscles. Strengthening the weaker, over-powered muscles of the neck and shoulders may help correct poor posture, thus decreasing nerve and blood vessel compression.

Yoga is therapeutic exercise that lessens muscle tension, increases flexibility, promotes relaxation, and restores proper movement patterns—all of which may be helpful in combating the sources of TOS.

GYROTONIC is an exercise method that emphasizes expansive motion away from the center of the body. This newer form of exercise opens the joints, decreases muscle limitations, provides increased mobility to the supporting structures, and helps with movement pattern re-education of the spine, rib cage, shoulders, and arms.

Nerve slides are non-resistance, non-exertion motion exercises, which help prevent scar tissue encasement of nerves. When a nerve is compressed, the surrounding tissues do not slide over the nerve correctly, which leads to scar tissue formation and multiple locations of nerve impingement. Nerve slides for the brachial plexus can help lessen current symptoms and prevent further symptoms by re-establishing correct motion between the muscles surrounding the nerves.

Thoracic outlet syndrome can be a debilitating condition if not treated promptly and thoroughly. Do not wait to see "if it will go away." Seek professional medical care immediately and use consistent therapeutic treatment and exercise to eliminate the origin of your TOS symptoms.

Prevention is the best medicine when it comes to TOS. Strengthening and stretching exercises to develop good posture, correct strength imbalances, and create proper movement patterns are vital in the prevention of TOS and other upper extremity conditions. Proper work station ergonomics for your body's frame can also help prevent thoracic outlet syndrome and other upper extremity nerve compression conditions.

This article mentions some key points, but here are a few additional important things to keep in mind about thoracic outlet syndrome (TOS):

TOS is thought to arise from one of two predominant mechanisms: nerve compression or blood vessel compression. Thus, TOS is divided into two broad syndromes—those which produce mostly neurologic dysfunctions and those which produce mostly vascular dysfunctions. Sorting the two syndromes is clinically challenging and not always possible, but, nevertheless, TOS may be mostly neurologic or mostly vascular in etiology.

There's also another cause of TOS I'd like to mention: Rarely, but importantly, thoracic outlet syndrome is the result of a serious underlying disorder. An example of this is tumors in the upper lung, which can compress either the nerves or blood vessels of the thoracic outlet, producing symptoms of TOS.

I would also like to point out that while certain treatments, such as chiropractic and yoga, can be effective for treating TOS, there is no scientific evidence that GYROTONIC exercises are helpful in treating TOS. In addition, GYROTONIC exercises appear to require proprietary and potentially expensive equipment.

Donald A. Ozello, DC

Dr. Ozello's response to Dr. Miglis' comments:

When TOS-like symptoms arise, a more serious pathology must always be ruled out as the source.

Nerve slide exercises are simple exercises that one can learn from a trained medical professional and perform anytime during the day.

GYROTONIC exercise must be taught and supervised by a trained professional using specific equipment.

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